Hospital bills routinely include information about monetary amounts. Examples include the amount of a no-fault insurance payment made on behalf of a Medicare beneficiary and the amount to be applied to the patient's deductible by the provider. These financial data elements are grouped together under a set of codes called value codes. Depending on the billing circumstances, the appropriate value codes and related amounts are recorded in FLs 39–41 on the UB-04. Several lines are provided in each field because more than one value code is often required on a single claim.

The payer needs to know the information conveyed by the value code and amount in order to pay the claim accurately and in a timely manner. This chapter provides instructions on what value codes are available, how related dollar amounts (units or number of visits) are reported for each code, and which codes are required in various billing situations. The codes relate to a wide range of billing circumstances.

In this chapter, each numerical value code is briefly described, and important details and billing tips are explained. General value codes are listed first, followed by a group of codes that are mostly specific to home health services or are payer-only codes. At the end of the chapter, the relevant alphanumeric codes (A0-ZZ) are described. Appendix A provides a list of value codes for quick reference.

Learning Objectives